A systematic review of the motivations for the non-medical use of prescription drugs in young adults

Nonmedical Use of Controlled Medications by Adolescents and Young Adults: Clinical Report

Nonmedical prescription drug use (NMPDU), the use of controlled prescription medications for purposes other than initially intended by the prescriber, is common among adolescents and young adults (AYAs). Prescription stimulants, sedatives, and opioid medications are the 3 main categories of controlled medications nonmedically used by AYAs. The intent of this clinical report is to provide an overview of the epidemiology, motives, sources, and risk factors of NMPDU among AYAs. This report also describes acute and long-term morbidity and mortality associated with NMPDU and discusses the importance of primary and secondary prevention to reduce the burden of NMPDU among AYAs. This report concludes with a series of recommendations on how pediatricians can address NMPDU with patients and their families.

Development and Validation of a Questionnaire for Assessing Drug Use Motives in the General Population in South Korea

Drug use is increasing in South Korea, necessitating evidence-based policy interventions. However, there is a dearth of reliable tools for identifying the personal and psychological factors that drive drug use among Korean adults. In this study, we developed and validated an instrument based on a motivational model to measure drug use motivation in the Korean context. A survey was administered online to 250 Korean adults aged 19-59. Of the initial 37 potential items evaluated, 23 were retained after exploratory factor analysis. Based on their relevance and factor loadings, the final scale consisted of 15 items distributed across five distinct factors: enhancement, coping, social, positive expectancy, and negative expectancy. Confirmatory factor analysis validated the strong fit of the five-factor model. Criterion-related validity was demonstrated by the significant correlations between the five factors and the selected criterion variables. This instrument can be used in research initiatives related to drug addiction and can provide basic data for policy interventions intended to curb drug addiction problems in South Korea. The novelty and broad applicability of this instrument make it invaluable for exploring the psychological underpinnings of drug use in South Korea.

Prevalence and associated factors of non-medical use of prescription drugs among adolescents in secondary schools in Buea, Cameroon: a cross-sectional study

BACKGROUND

The non-medical use of prescription drugs is a growing public health problem worldwide. Recent trends in Cameroon show that the use of psychoactive substances, among which are prescription drugs by adolescents is becoming a public health issue and is linked to juvenile delinquency and violence in schools. However, there is a paucity of data on the burden of this phenomenon among adolescent secondary school students in the country. The aim of this study was to determine the prevalence and factors associated with the use of non-prescription drugs in secondary schools in Buea, South West region of Cameroon.

METHODS

We conducted a cross-sectional study from 1st February 2021 to 30th April 2021. Secondary school students were recruited using a multistage stratified cluster sampling. A modified and standardized version of the World Health Organization student drug-use survey model questionnaire was used. Ethical approval was obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea (No. 2021/1273-02/UB/SG/IRB/FHS). The Statistical Package for Social Sciences, IBM SPSS Statistics for Windows, Version 25.0. was used for data analysis. Descriptive statistics were used to describe the sociodemographic characteristics of participants. Univariate and multivariate logistic regression models were used to explore associated factors of non-medical use of prescription drugs.

RESULTS

A total of 570 participants were enrolled for the study, and 510 participants responded giving a response rate of 89.5%. The prevalence of non-medical use of prescription drugs was 15.3%, tramadol being the most used. Motivators for non-medical use of prescription drugs were "to work longer", "to be courageous", and "curiosity". Logistic regression results showed that alcohol consumption [OR 3.68; 95% CI: 2.24-6.06; p < 0.001], smoking [OR 6.00; 95% CI: 3.07-11.75; p < 0.001] and use of illicit drugs [OR 10.85; 95% CI: 5.48-21.48; p < 0.001] were independent factors associated with non-medical use of prescription drugs.

CONCLUSION

Non-medical use of prescription drugs was prevalent among adolescent secondary school students in Buea, Cameroon. Tramadol is the main drug of prescription involved. Our results can guide policymakers on strategies to screen, prevent and control non-medical use of prescription drugs among secondary school students in Cameroon.

Other Momentary Substance Behaviors as Predictors of College Students' Prescription Drug Misuse in Daily Life: An Exploratory Study

Background

Limited prior research to examine co-occurrence of prescription drug misuse with other substances among young adults has documented outcomes that are more problematic for those with higher rates of co-ingesting alcohol. There is a need to understand how college students in this period of heightened risk use other salient substances in moments of their prescription misuse in daily life.

Method

Young-adult college students who engaged in recent prescription misuse (N = 297) completed ecological momentary assessment (EMA) over a 28-day period, resulting in 23,578 reports. Multilevel modeling examined within-person associations between other momentary substance use (including alcohol, nicotine, energy drinks, and marijuana) and prescription misuse in daily life. Analyses accounted for between-person characteristics, having a current focal prescription, and effects of reporting over time. Participant sex was also explored as a moderator.

Results

In adjusted multilevel models, college students' momentary nicotine use and energy drink use each were associated with their greater likelihood of prescription misuse in daily life. In contrast, momentary marijuana use was linked with lower likelihood of misuse. Moderation results indicated that males (but not females) were less likely to engage in prescription misuse in moments of their alcohol use.

Conclusions

Drawing from data obtained using EMA, findings provide novel insights about the real-world associations between prescription drug misuse and other salient substance behaviors during a developmental period that is important for establishing later substance use and health.

Validation of the Motivational Inventory Underlying Substance Use Engagement (MI-USE)

Given the growing number of fatalities associated with the use of multiple types of drugs, there is an urgent need for a tool that allows clinicians and researchers to quickly assess diverse reasons for substance use. Here, we sought to validate the Motivational Inventory Underlying Substance Engagement (MI-USE), a new measure that assesses motivations for use across different types of substances. Participants were 538 adults ages 18-60 (48% women) who reported substance use problems and past-year drug or alcohol use. Analyses were conducted to discover and validate the factor structure of the MI-USE and evaluate its construct validity. A 30-item model best fit the MI-USE, with one General Factor capturing overall motivation to engage in substance use and eight motive-specific factors that indexed unique motivations for substance use: Emotional Coping (relief from unpleasant emotions), Pleasure-Seeking (feel pleasurable or exciting emotions and sensations), Dependence Severity (avoid withdrawal and cravings), Expansion (enhance self-insight and spirituality), Social Coping (increase confidence and attractiveness), Advantage (gain a physical or mental advantage), Physical Coping (relief from unpleasant bodily sensations), and Sleep (mitigate sleep problems). Evaluation of the measure's construct validity and internal consistency support the chosen model and interpretation of the motive-specific factors. Results provide initial validation of the MI-USE as a reliable and valid tool for assessing diverse substance use motivations. It improves upon existing measures by allowing clinicians and researchers to simultaneously evaluate motivations for multiple forms of substance use, which facilitates personalized treatment planning and research on polysubstance use.

Internalized Heterosexism and Substance Use: A Meta-Analysis

Sexual minority individuals report greater rates of substance use compared to their heterosexual counterparts. Internalized heterosexism (IH) is one critical factor underlying this disparity. There has been a proliferation of studies examining IH as a correlate of substance use; however, results of these studies have been mixed. The purpose of the current multilevel meta-analysis was to explain these mixed findings by identifying factors that moderate the overall relationship between IH and substance use. Results from the analysis of 49 studies (209 effect sizes and 162,674 participants) demonstrated a positive overall relationship between IH and substance use ( r = .065). This relationship was significantly moderated by sexual orientation, gender, and type of substance. Increased IH was linked to increased use of heroin ( r = .173), cocaine ( r = .135), tobacco ( r = .100), and alcohol ( r = .070). Implications for research, practice, and policy are discussed.

Motivations for Prescription Drug Misuse Related to Mental Health Problems in Adults

BACKGROUND

Prescription drug misuse (PDM) is a significant public health problem associated with mental health symptoms.

OBJECTIVES

This project investigates the connections between PDM motivations and mental health to inform intervention efforts.

METHODS

Using nationally representative adult data from the 2016-2018 National Survey on Drug Use and Health (N = 128,205; 53% female) this project investigated which motivations for misuse are related to past-year mental health problems including any mental illness, serious mental illness, major depressive episode, and suicidal thoughts. Complex samples logistic regression models of the main motivation of PDM for each mental health problem were conducted separately for each prescription drug class (i.e., opioids, tranquilizers, sedatives, and stimulants) while controlling for demographic characteristics.

RESULTS

Adults that reported PDM were more likely than those with no PDM to endorse past year mental health problems. Compared to those that reported PDM of other medications, those misusing prescription opioids and tranquilizers to help with emotions and misusing sedatives to "relax or relieve tension" were more likely to have all categories of mental health problems. Those that misused prescription stimulants to "help study" had lower odds of all mental health problems.

CONCLUSIONS

While there were differences based on prescription drug class, a range of motivations increased adults' likelihood to have mental health problems and common themes were found across drug classes. While causality is still undetermined, prevention and intervention efforts that are multifaceted and individualized, while broadly providing adults with other ways to cope with negative emotions are likely to help reduce PDM.

Motives for Substance Use in Daily Life: A Systematic Review of Studies Using Ecological Momentary Assessment

The motivational model of substance use posits four motive subtypes (coping, enhancement, social, conformity) dynamically interact with contextual factors to impact decisions about substance use. Yet, prior studies assessing the motivational model have relied on between-person, cross-sectional evaluations of trait motives. We systematically reviewed ecological momentary assessments (EMA) studies (N=64) on motives for substance use to examine: methodological features of EMA studies examining the motivational model, support for the motivational model between and within individuals, and associations between trait motives and daily processes. Results of the reviewed studies provide equivocal support for the motivational model, and suggest that EMA measures and trait measures of motives might not reflect the same construct. The reviewed body of research indicates most studies have not examined the momentary and dynamic nature of the motivational model and more research is needed to inform interventions that address heterogeneous reasons for substance use in daily life.

Nonmedical use of prescription drugs and biopsychosocial correlates among females who are sex workers in China

Background: Nonmedical use of prescription drugs (NMPUD) has become a critical public health concern. Chinese literature has paid growing attention to NMUPD, but scarce research has focused on females who are sex workers (FSWs), who have a high risk of substance use. The current study aimed to examine NMUPD and its biopsychosocial correlates in Chinese FSWs. Methods: A total of 410 FSWs (mean age = 33.58 years) from Guangxi, China, completed an anonymous, self-administered survey evaluating NMUPD, somatic symptoms, and psychosocial distress. Results: Overall, 46.6% of FSWs reported lifetime NMUPD and 17.6% reported past-3-month NMUPD. The most commonly reported medications that were used nonmedically were analgesics (46.3%, lifetime; 17.6%, past 3 months). A majority of FSWs (69.1%) reported "relieving pain" as the motive of their NMUPD. FSWs reporting NMUPD were more likely to be younger, be unmarried, have higher income, and work in multiple venues/high-paying venues. Somatic symptoms and psychosocial distress were associated with NMUPD in Chinese FSWs. Conclusions: NMUPD was prevalent in Chinese FSWs and was associated with biopsychosocial factors. Critical attention should be paid to NMUPD in FSWs. Future NMUPD prevention intervention among FSWs may benefit from attending to biopsychosocial factors.

A supportive school environment may reduce the risk of non-medical prescription opioid use due to impaired mental health among students

Canada is in the midst of an ongoing, escalating opioid crisis, with significant impacts on adolescents and young adults. Accordingly, mental health impairment was examined as a risk factor for non-medical prescription opioid use (NMPOU) among high school students. In addition, the moderating effects of the school environment, in terms of the availability of mental health services and substance use policies, were characterized. Self-reported, cross-sectional data were obtained from the COMPASS study, including 61,239 students (grades 9-12) in 121 secondary schools across Canada. Current and lifetime NMPOU were ascertained. Categorical indicators of mental health impairment and school environment were derived. The main analytical strategy encompassed hierarchal multilevel logistic regression, including the addition of interaction terms to characterize the moderation effects. Current and lifetime NMPOU were reported by 5.8% and 7.2% of the students, respectively. After adjusting for confounders, students in the highest quintile of mental health impairment had odds ratios (OR) of 2.60 (95% confidence interval [CI] 2.29-2.95) and 2.96 (95% CI 2.64-3.33) for current and lifetime NMPOU, respectively when compared to students in the lowest quintile of mental health impairment. A significant interaction between mental health impairment and school environment indicated relatively lower risks of NMPOU in students from schools that provide more mental health services and have stricter substance use policies. Mental health impairment increased the risk of NMPOU, but the associations were moderated by the school environment. These findings underscore the importance of mental health services and substance use regulations in schools.

Determinants of sleep quality in college students: A literature review

PURPOSE

To review the various determinants of sleep quality among college students.

METHODS

The PubMed, Web of Science and Cochrane Library databases were searched with the search string "sleep quality" AND "college students" for articles published between January 2007 and October 2017. Articles were excluded if they (1) examined sleep quality as a risk factor for other outcomes or (2) involved inpatients or participants under medical care.

RESULTS

The 112 identified studies were classified into categories according to the investigated determinants and their effect on sleep quality. Physical activity and healthy social relations improved sleep quality, while caffeine intake, stress and irregular sleep-wake patterns decreased sleep quality. Less consistent results were reported regarding eating habits and sleep knowledge, while proper napping during the day might improve overall sleep quality.

CONCLUSIONS

College students are vulnerable to different risk factors for sleep quality. When designing interventions to improve sleep quality among college students, the main determinants need to be taken into consideration.

Motivations for the nonmedical use of prescription drugs in a longitudinal national sample of young adults

INTRODUCTION

People's motivations for nonmedical use of prescription drugs (NMUPD) are not well studied, particularly in longitudinal representative samples. However, understanding which motivations are most popular and how these change over time for specific groups is important to inform interventions for NMUPD.

METHODS

The current study examined how young adults' motives for NMUPD changed over young adulthood, using a nationally representative sample of 12,223 young adults in 36 cohorts (1976-2012) as part of the Monitoring the Future study across three biennial waves (waves 1, 2, 3: modal ages 19/20, 21/22, and 23/24 years). We investigated these young adults' motivations for using stimulants, central nervous system depressants, and opioids when controlling for possible cohort effects. We included sex and college attendance as potential moderators.

RESULTS

Participants commonly reported recreational and self-treatment motivations over time and across drug classes, reporting four to five popular motivations in each drug class. Generalized estimating equations repeated measure analyses revealed relatively stable NMUPD motivations across young adulthood. Participants reported some reductions in experimentation and boredom as motivations for NMUPD and increases in certain self-treatment motivations, depending on prescription drug class. Overall, men were more likely to endorse recreational motivations, whereas women were more likely to endorse self-treatment motivations, though this varied somewhat by prescription drug class. Young adults not enrolled in college courses were more likely to endorse using stimulants nonmedically for different reasons than their peers who were enrolled.

CONCLUSIONS

NMUPD prevention and treatment efforts tailored to the young adult population should include methods to reduce both self-treatment and recreational use and need to consider prescription drug class, sex, and college attendance.

Using the Woodcock-Johnson IV tests of cognitive abilities to detect feigned ADHD

Research has suggested that many young adults can successfully feign ADHD, reporting clinically significant symptom levels and displaying deficits on cognitive tasks when asked to do so. Standalone performance validity tests (PVTs) have shown some success in identifying feigned ADHD, but these tests are rarely used in typical ADHD evaluation batteries. The present study attempted to develop embedded PVT indices from the Woodcock-Johnson IV Tests of Cognitive Abilities (WJ-IV). College students (N = 150) completed a battery including tasks from the WJ-IV, as well as an established standalone PVT and a rating scale measuring ADHD and related symptoms. Thirty of the students had been professionally diagnosed with ADHD; of the remaining 120 students, half were asked to perform honestly and to the best of their ability on the battery, whereas the other half were asked to try to simulate ADHD. Several processing speed and working memory scores from the WJ-IV effectively identified students feigning ADHD, detecting at least 50% of those students at score cutoffs that also maintained specificity of 90% or more, close to the efficiency of the standalone PVT. In addition, students with ADHD diagnoses generally did not show deficits on the WJ-IV. Implications for practice and future research are discussed.

The Use of Non-Prescribed Prescription Drugs and Substance Use Among College Students: A 9-Year Follow-Up Cohort Study

The use of non-prescribed prescription drugs (NPPD) is common in post-modern societies and a significant proportion of youth consume NPPD concomitantly to other drugs. We studied the prevalence of this consumption among university students in Spain, and its relationship to different patterns of alcohol, tobacco, and cannabis use. A cohort study among university students (n=1,380) (2005-2015) was carried out. Students completed self-administered questionnaires at initial (n=1,363, 98.7%), at 2 years (n=875, 75%) and 9 years of follow-up (n=415, 30.5%). Consumption of medicines (last 15 days), risky alcohol consumption (RC), heavy episodic drinking (HED), and tobacco and cannabis use were measured. Multilevel logistic regressions for repeated measures were generated using consumption of medicines with or without medical prescription as dependent variables. Prevalence of RC, HED, tobacco and cannabis had significant reductions during the follow-up. The use of NPPD increased over time, from 35.5% and 33.3% at 18 and 22 years old, respectively, to 49.6% at 27 years old. The highest rates were found among cannabis, tobacco, RC and HED users. For females, cannabis and RC constitute signitifant risk factors for use of NPPD. Conversely, for males, tobacco and cannabis were risk factors for such use of medicines. Later onset of alcohol consumption constitutes a protective factor for females. Our results reveal high prevalence of NPDD among university students. Those who consume NPPD are -at the same time- more likely to be alcohol, tobacco, and cannabis users than those who take medication under prescription. Preventive strategies should be reinforced and focused on this target population to decrease these high levels of poly-consumption.

Reasons for non-medical use of prescription opioids among young adults: Role of educational status

Non-medical use of prescription opioids (NMUPO) and related overdoses are disproportionately elevated among young adults. Efforts to understand the underlying reasons for NMUPO are critical for developing more effective prevention and intervention strategies for this group. Given the robust literature on the association between educational status and substance abuse risk, we examined the reasons for NMUPO through the lens of educational attainment among young adults. Data from the 2016 National Survey on Drug Use and Health came from an unweighted sample of 941 young adults aged 18-25 years who reported past-year NMUPO. Self-reported reasons for most recent NMUPO were compared by educational status. The most commonly-endorsed reasons for past-year NMUPO was physical pain relief (47.6%), followed by feel good/get high (19.8%), relax/relieve tension (13.2%) and experiment/see what it feels like (6.8%). Reasons for NMUPO did not differ as a function educational status (p = 0.17). These findings suggest that efforts to prevent and address opioid misuse among young adults should focus on understanding and improving pain management in this vulnerable population.

Heavy Drinking and Non-Medical Use of Prescription Drugs among University Students: A 9-Year Follow-Up

Purpose: Investigations suggest non-medical use of prescription drugs (NMUPD) is associated with heavy drinking and polydrug use among university students. Our aim is to determine the prevalence of NMUPD among university students and to analyze its association with alcohol, tobacco, and cannabis use, and to study the role of the age of drinking onset. Methods: Cohort study among university Spanish students (n = 1382). Heavy drinking (HED) and risky consumption (RC) were measured with the Alcohol Use Disorders Identification Test. Questions related to tobacco and cannabis consumption were also formulated. NMUPD refers to sedative, anxiety, or pain medication intake within the last 15 days without medical prescription. All variables were measured at 18, 20, and 27 years. Multilevel logistic regression for repeated measures was used to obtain adjusted OR (odds ratios). We analyzed the results from a gender perspective. Results: Prevalence of NMUPD were higher in students who already partook in NMUPD at the beginning of the study. NMUPD in women at 27 is 3 times higher than at 18, while in men it is twice. Among females, RC (OR = 1.43) and cannabis consumption (OR = 1.33) are risk factors for NMUPD, while later onset of alcohol use (OR = 0.66) constitutes a protective factor. No significant differences were found for males. Conclusions: NMUPD is prevalent among university students. RC and early onset of alcohol use were associated with higher prevalence of NMUPD in females. The prevalence of NMUPD increased with age in both sexes. Strategies for reducing risky drinking and delaying onset of drinking should be provided for university students. Pharmacists and parents should be alerted to the risk of NMUPD.

Prevalence and Correlates of Depressive Symptomology among Young Adults Who Use Prescription Opioids Non-medically

Non-medical prescription opioid (NMPO) use and depression frequently co-occur and are mutually reinforcing in adults, yet NMPO use and depression in younger populations has been under-studied. We examined the prevalence and correlates of depressive symptomology among NMPO-using young adults. The Rhode Island Young Adult Prescription Drug Study (RAPiDS) recruited young adults in Rhode Island who reported past 30-day NMPO use. We administered the Center for Epidemiologic Studies Short Depression Scale (CES-D 10), and used modified Poisson regression to identify the independent correlates of depressive symptomology (CES-D 10 score ≥10). Over half (59.8%, n = 119) screened positive for depressive symptomology. In modified Poisson regression analysis, diagnostic history of depressive disorder and childhood verbal abuse were associated with depressive symptomology. Participants with depressive symptomology were more likely to report using prescription opioids non-medically to feel less depressed or anxious, to avoid withdrawal symptoms, and as a substitute when other drugs are not available. Among young adult NMPO users, depressive symptomology is prevalent and associated with distinct motivations for engaging in NMPO use and represents a potential subgroup for intervention. Improving guidelines with tools such as screening for depressive symptomology among young adult NMPO users may help prevent NMPO-related harms.

Motives for prescription stimulant use by patterns of non-medical use

Background

Understanding motivations behind non-medical use of prescription stimulants (NMUPS) is important to prevent such use.

Methods

Adult participants from St. Louis, MO, who endorsed NMUPS on 5 or more days in the past 12 months (n=60) were asked about their motivations for use. Associations between motives for use and patterns of non-medical use in the past 12 months were assessed using multivariable logistic regression, controlling for demographic factors and non-medical use of other prescription drugs.

Results

On average, 5.5 different motives for stimulant use were endorsed. Compared to those who only used someone else's stimulants, adults who only used stimulants other than prescribed were less likely to endorse use "to get high" (aOR=0.48, 95%CI 0.26-0.90) and more likely to endorse use "to function" (aOR=1.97, 95%CI 1.04-3.75); adults who were engaged in both patterns of NMUPS were more likely to endorse use "to function" (aOR=4.12, 95%CI 1.56-10.88) and "to modify the effects of other drugs" (aOR=2.29, 95%CI 1.13-4.61).

Conclusion

Although using stimulants for performance enhancement is common, most people who used diverted stimulants reported using stimulants to get high. Prevention and harm reduction strategies should consider these differences.

Sex differences in patterns of prescription opioid non-medical use among 10-18 year olds in the US

BACKGROUND

Non-medical use (NMU) of prescription opioids is a public health concern and sex differences in prevalence of NMU have been observed previously. Little is known about how youth are obtaining and using these drugs. While any regular use could be problematic, NMU is particularly concerning. More information is needed on NMU patterns among youth and how these patterns might differ by sex.

METHODS

The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) recruited youth 10-18 years of age from 10 US metropolitan areas from 2008 to 2011 with a final sample of 11,048 youth. The cross-sectional survey included questions on past 30 day use of prescription opioids (10,965 provided responses), with NMU defined as non-oral use and/or use of someone else's opioids. NMU through use of a patient's own prescription orally for a reason other than prescribed could not be identified, though this is usually contained within the standard definition of NMU.

RESULTS

Among the 10,965 youth, past 30 day prevalence of NMU of prescription opioids was 3.1% (n = 345) with 59.7% (n = 206) using someone else's opioids only, 5.2% (n = 18) having non-oral use only and 35.1% (n = 121) having both. In total, seven sources and three routes of administration were assessed. The most common source among males was someone from school (n = 111, 60.0%), with no highly prevalent second source. Among females, there were two prevalent sources of prescription opioids; a parent (n = 59,41.6%) and someone from school (n = 53,37.3%). For non-oral use, snorting prescription opioids was more frequent among males compared to females (n = 85, 31.8% and n = 44, 17.1%; p < .01).

CONCLUSIONS

Based on these findings, to combat the current opioid crisis, implementation of strategies to prevent youth from sharing opioids, especially with friends from school, should be considered and tested.

Predicting Future Academic Willingness, Intentions, and Nonmedical Prescription Stimulant (NPS) Use with the Theory of Reasoned Action and Prototype/Willingness Model

Background: Nonmedical prescription stimulant (NPS) use for academic reasons (e.g., to improve concentration) is a growing problem among college students. However, there is limited theory-driven research that attempts to identify risk cognitions underpinning decisions to use and NPS use for academic purposes. Furthermore, it is unclear if academic NPS use is characterized by deliberative and/or socially reactive processing and what health decision-making model or combination of models best predicts NPS use decisions and use. Identifying cognitions associated with NPS use decisions is essential to develop interventions aimed at preventing and reducing NPS use. Objective: The present study tested the Theory of Reasoned Action (TRA), Prototype/Willingness Model (PWM), and a combined TRA/PWM model to identify which model best predicts academic NPS use decisions (willingness and intentions) and past 2-month use among college students. Method: Undergraduates (N = 344) participated in a two-wave study assessing T1 constructs from the TRA and PWM as predictors of T2 (2 months later) academic NPS use decisions and use. Results: In the combined TRA/PWM, all T1 constructs were associated with T2 NPS willingness, intentions, and use except for injunctive norms. The integrated model also explained greater variance in T2 use, willingness, and intentions than each model alone. Conclusions/Importance: The combination of cognitions from the TRA/PWM was superior to each individual model and improved the prediction of future NPS use willingness, intentions, and use. The overall results derived from all three models suggest that both deliberative and socially reactive processing influence and characterize academic NPS use decisions and use.

Alcohol use disorder and motives for prescription opioid misuse: A latent class analysis

Introduction: Among those who misuse prescription opioids, alcohol use disorder (AUD) is associated with progression to opioid use disorder, risk of overdose, and poor treatment outcomes. However, little is known about co-occurring AUD and prescription opioid misuse. Motives, or reasons, for substance use are important factors in substance use initiation and maintenance; characterizing common motives can help inform treatment targets. The aims of the present study were to (1) identify patterns of motives for prescription opioid misuse, and (2) examine the association between AUD and motives. Methods: Data were extracted from the 2015 National Survey on Drug Use and Health. Analyses included adult respondents with past-year prescription opioid misuse (N = 2,627), of which 24.2% had a co-occurring AUD. Latent class analysis was utilized to identify patterns of motives for prescription opioid misuse. AUD was included as a predictor of class membership. Results: We identified three classes: (1) pain relief (56.1% of the sample), (2) recreational (e.g., to get high; 29.3%), and (3) mixed motives (e.g., coping, pain relief, recreational; 14.6%). AUD was associated with greater odds of membership in the recreational (OR = 2.05, 95% CI = 1.36, 3.10, p = .001) and mixed motives (OR = 2.11, 95% CI = 1.21, 3.67, p = .008) classes, as compared to the pain relief class. Results: Pain relief was the most commonly endorsed motive for opioid misuse among those with and without AUD. These results underscore the need to improve pain management among those who misuse prescription opioids. Those with co-occurring AUD might also benefit from interventions targeting negative affect and/or positive outcome expectancies.

Borderline personality disorder features and drinking, cannabis, and prescription opioid motives: Differential associations across substance and sex

INTRODUCTION

Drinking motives have shown meaningful associations with borderline personality disorder (BPD) features. However, it is unknown whether other common substances of abuse (namely cannabis and prescription opioids) have the same associations with BPD features. In the present study, we tested associations between BPD features and motives across three substances: alcohol, cannabis, and prescription opioids. The purpose of the study was to determine whether BPD showed similar patterns of associations across drugs, or whether some substances serve particular functions for individuals with BPD features, and whether this also varies by sex in a college student sample.

METHOD

Five-hundred ninety-four college students completed online questionnaires measuring demographics, borderline personality disorder features, substance use, and substance specific motives for alcohol, cannabis, and prescription opioid use.

RESULTS

BPD was most strongly associated with coping motives across all substances. For both alcohol and cannabis, this was true for both males and females, along with conformity motives. For prescription opioids, coping, social, enhancement, and pain motives were only significantly related to BPD features for females. When compared statistically, it was found that the associations with coping drinking motives and opioid pain motives were higher among females.

CONCLUSIONS

This pattern of results suggests that negatively reinforcing motives (coping and conformity) play a similar functional role in borderline personality and substance use disorder pathology for alcohol and cannabis, but for prescription opioids the negative reinforcement motives (coping and pain) were only evident in females.

Untreated depression and non-medical use of prescription pain relievers: findings from the National Survey on Drug Use and Health 2008-2014

OBJECTIVES

Despite growing concerns for non-medical use of prescription pain relievers (NMUPPRs), little is known about the role of comorbid, untreated depressive disorders.

METHODS

We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12-17 years) and adults (18 or older). Prevalence estimates with 95% confidence intervals were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse. In order to explore whether MDE effect might change by treatment received, a model with an interaction term including MDE and treatment was fit.

RESULTS

Among respondents, about 9% (youths) and 7% (adults) reported past year MDE and about 6% (youths), and 4% (adults) NMUPPRs. About 1.2% (youths) and 0.7% (adults) reported both MDE and NMUPPRs. Those with past year MDE were more likely to report NMUPPRs (RR, 95%CI: 2.60, 2.42-2.80, and 2.64, 2.47-2.82, for youths and adults). Considering the any treatment/MDE interaction on NMUPPRs, MDE risk ratio for subjects who received some treatment (youths: adjusted risk ratio (ARR) = 1.15; adults: ARR = 1.25) was about 70-80% as compared with their untreated counterpart (youths: ARR = 1.57; adults: ARR = 1.54). The likelihood of reporting NMUPPRs amongst respondents who did not receive any treatment was higher for those with past year MDE (main effect: youths ARR = 1.57, p < 0.001; adults ARR = 1.54, p < 0.001).

CONCLUSION

Unrecognized and untreated depressive disorders should be considered for prevention, treatment, and policy implications in order to tackle NMUPPRs epidemic.

Nonmedical Use of Prescription Stimulants Among US High School Students to Help Study: Results From a National Survey

OBJECTIVE

Mixed findings exist regarding extent and efficacy of nonmedical use of prescription stimulants (NMUPS) for study enhancement (SE). This national study of US high school seniors examined NMUPS for SE and addressed risk/benefit questions: To what extent are students reporting NMUPS specifically for SE, and do these individuals demonstrate fewer problem behaviors and superior academic performance?

METHOD

Total of 15 098 US students surveyed (2009-2015) and divided into 4 subgroups: (1) no past-year NMUPS (nonusers), (2) past-year NMUPS to help study (NMUPS-SE only), (3) past-year NMUPS for study/nonstudy motives (NMUPS-SE+ other), and (4) past-year NMUPS for nonstudy motives (NMUPS-nonSE only). Student characteristics (eg, grade point average [GPA]) and substance-related problems (eg, binge drinking) compared between subgroups.

RESULTS

Among students who reported past-year NMUPS (n = 781), 7.4% reported NMUPS-SE only, 40.9% NMUPS-SE+ other, and 51.7% NMUPS-nonSE only. Odds of binge drinking, cigarette smoking, marijuana, and opioid nonmedical use significantly higher among all NMUPS subgroups. GPAs significantly lower among subgroups reporting NMUPS nonstudy motives; did not differ between NMUPS-SE only and nonusers.

CONCLUSIONS

7% of US high school seniors engaged in NMUPS for SE only (0.4% total population). Findings indicate greater substance-related problems without superior academic performance among NMUPS-SE subgroups.

The Role of Adenosine Receptors in Psychostimulant Addiction

Adenosine receptors (AR) are a family of G-protein coupled receptors, comprised of four members, named A1, A2A, A2B, and A3 receptors, found widely distributed in almost all human body tissues and organs. To date, they are known to participate in a large variety of physiopathological responses, which include vasodilation, pain, and inflammation. In particular, in the central nervous system (CNS), adenosine acts as a neuromodulator, exerting different functions depending on the type of AR and consequent cellular signaling involved. In terms of molecular pathways and second messengers involved, A1 and A3 receptors inhibit adenylyl cyclase (AC), through Gi/o proteins, while A2A and A2B receptors stimulate it through Gs proteins. In the CNS, A1 receptors are widely distributed in the cortex, hippocampus, and cerebellum, A2A receptors are localized mainly in the striatum and olfactory bulb, while A2B and A3 receptors are found at low levels of expression. In addition, AR are able to form heteromers, both among themselves (e.g., A1/A2A), as well as with other subtypes (e.g., A2A/D2), opening a whole range of possibilities in the field of the pharmacology of AR. Nowadays, we know that adenosine, by acting on adenosine A1 and A2A receptors, is known to antagonistically modulate dopaminergic neurotransmission and therefore reward systems, being A1 receptors colocalized in heteromeric complexes with D1 receptors, and A2A receptors with D2 receptors. This review documents the present state of knowledge of the contribution of AR, particularly A1 and A2A, to psychostimulants-mediated effects, including locomotor activity, discrimination, seeking and reward, and discuss their therapeutic relevance to psychostimulant addiction. Studies presented in this review reinforce the potential of A1 agonists as an effective strategy to counteract psychostimulant-induced effects. Furthermore, different experimental data support the hypothesis that A2A/D2 heterodimers are partly responsible for the psychomotor and reinforcing effects of psychostimulant drugs, such as cocaine and amphetamine, and the stimulation of A2A receptor is proposed as a potential therapeutic target for the treatment of drug addiction. The overall analysis of presented data provide evidence that excitatory modulation of A1 and A2A receptors constitute promising tools to counteract psychostimulants addiction.

Nonmedical use of over-the-counter medications is significantly associated with nonmedical use of prescription drugs among university students

OBJECTIVE

To examine the association between nonmedical use of over-the-counter medications (NMUOTC) and nonmedical use of prescription drugs (NMUPD).

PARTICIPANTS

University students surveyed on NMUOTC and NMUPD between August and December 2011 (N = 939).

METHODS

Cross-sectional data analysis of online survey.

RESULTS

The majority of respondents were women, undergraduate, Caucasian, and not affiliated with Greek life. NMUPD and NMUOTC were reported by 21.4% and 11.2% of students, respectively. NMUOTC was significantly associated with NMUPD in unadjusted analyses and after adjustment for gender, age, race/ethnicity, and Greek membership (odds ratio: 3.37, 95% confidence interval: 2.17, 5.23). Secondary analyses showed a relationship between over-the-counter (OTC) cough medication misuse and NMUPD, OTC stimulant misuse and prescription stimulant misuse, and OTC sleep aid misuse with prescription depressant misuse.

CONCLUSIONS

Results suggest the importance of both measuring the prevalence of OTC misuse and incorporating its misuse into assessments of polydrug use in the university population.

Motives for illicit prescription drug use among university students: A systematic review and meta-analysis

BACKGROUND

There is a growing body of research on the motives for prescription drug misuse (PDM) among university students. However, the overall findings of this research are hard to decipher. Studies use different methods, they examine different drug types, the motives are phrased in various ways, and the results differ widely. In order to make sense of this body of knowledge, it is necessary to synthesise the results across studies and draw out conclusions.

METHODS

The research comprises a systematic review and meta-analysis of studies on the motives of university students for illicit use of four different types of prescription medication (stimulants, analgesics, tranquillisers and sedatives). The search for studies was conducted on six bibliographic databases with stated criteria governing search eligibility and inclusion in the final review.

RESULTS

Overall, the most prevalent motives for PDM among university students cover some kind of personal enhancement to the user in terms of performance (in relation to sports, and academic outcomes), mental health (ability sleep, to reduce anxiety), or physical health (manage pre-existing illnesses). Fewer than half of users said that they were involved in PDM for pleasure purposes (to party, to get high, or to experiment).

CONCLUSION

PDM among students might be viewed as a means of self-improvement when other means of achieving desired objectives are unavailable or restricted. A more thorough understanding of motives for PDM, especially in relation to their influence on behaviour, might help in devising university-based treatment and prevention programmes.

Descriptive and injunctive network norms associated with nonmedical use of prescription drugs among homeless youth

BACKGROUND

Nonmedical use of prescription drugs (NMUPD) among youth and young adults is being increasingly recognized as a significant public health problem. Homeless youth in particular are more likely to engage in NMUPD compared to housed youth. Studies suggest that network norms are strongly associated with a range of substance use behaviors. However, evidence regarding the association between network norms and NMUPD is scarce. We sought to understand whether social network norms of NMUPD are associated with engagement in NMUPD among homeless youth.

METHODS

1046 homeless youth were recruited from three drop-in centers in Los Angeles, CA and were interviewed regarding their individual and social network characteristics. Multivariate logistic regression was employed to evaluate the significance of associations between social norms (descriptive and injunctive) and self-reported NMUPD.

RESULTS

Approximately 25% of youth reported past 30-day NMUPD. However, more youth (32.28%) of youth believed that their network members engage in NMUPD, perhaps suggesting some pluralistic ignorance bias. Both descriptive and injunctive norms were associated with self-reported NMUPD among homeless youth. However, these varied by network type, with presence of NMUPD engaged street-based and home-based peers (descriptive norm) increasing the likelihood of NMUPD, while objections from family-members (injunctive norm) decreasing that likelihood.

CONCLUSIONS

Our findings suggest that, like other substance use behaviors, NMUPD is also influenced by youths' perceptions of the behaviors of their social network members. Therefore, prevention and interventions programs designed to influence NMUPD might benefit from taking a social network norms approach.